Types of Germ Cell Tumors (GCT)

Testicular tumors are common and potentially annihilating to the male population. With a brief prologue to testicular tumors; this article focuses on the significant, relevant types of testicular tumors such as Germ Cell Tumors (GCTs) and Non-Germ Cell Tumors (NGCT).Various clinical, patho-physiological and prognostic aspects of the same have been expatiated.

00:02
Testicular tumor.
00:03
We’ll take a look at the
parameters or the categories.
00:07
Tumor, morphology, marker,
prognosis, remark.
00:11
Our first major germ cell
tumor is a seminoma.
00:15
Take a look at the picture here.
A cut section.
00:18
Do you see any blood in here?And very important
– none whatsoever.
00:22
Seminoma versus a
non-seminomatous germ cell tumorsare non-hemorrhagic.
00:29
Sometimes referred to as
being a walnut.
00:32
Okay. So if you cut
open a walnut,maybe perhaps this is what
it looks like on the inside.
00:36
That area that you’re
seeing within the testicle,that is more whitish would
be the actual tumorwithin the testicle.
00:43
Morphology here:
Fried-egg appearance.
00:46
And by fried egg,literally means as though
if you break open an egg,the yolk falls in the middle,
around it will be the albumin.
00:53
The white.
00:54
That’s a fried-egg appearance.
00:56
The nucleus will
be in the middle.
00:57
Fried egg is a non-specific
morphology or description.
01:01
You’ve heard of
oligodendroglioma,and that is a brain tumor
in which there once again,the appearance –With the morphology
would be fried egg.
01:10
Serum marker here, you’re going
to be using what’s known as yourhuman chorionic gonadotropin.
01:16
And you have something called
placental alkaline phosphatase.
01:22
Prognosis is excellent.
01:24
Here,if you’re thinking metastasis,
it will be through lymphatic.
01:28
Where is it going?Para-aorticand it is important that
you pay attention to howincredibly sensitive
it is to radiotherapy.
01:38
What you’re also doing is
comparing this seminoma,which is the most common of
all of your germ cell tumorsversus the non-seminomatous,
which we’ll get into next.
01:49
Embryonal:Well, the main thing
here about embryonalis you take a look
at the section hereand you find at this section -- and
you’ll find it to be hemorrhagic.
02:00
Hemorrhagic versus if you
take a look at seminoma,it looks like it’s
non-hemorrhagic.
02:08
Yolk sac tumor:Also call it endodermal
sinus tumor (EST).
02:13
Endodermal sinus tumorBut guess what?We did this for ovarian
tumor as well.
02:20
And with the ovarian tumor, remember once again,ovarian tumor, this is not the
most common family of tumors.
02:26
What family are we doing?Germ cell tumors.
02:30
For which gender?Males.
02:34
EST stands for
endodermal sinus tumor.
02:37
Here with the yolk sac,do you remember when
we had a discussionand if you haven’t quite
gotten into it, that’s okay.
02:43
But the fact that glomeruli,if you have these primitive
glomerular-like structuresthat you would find
with yolk sac tumor,you call this Schiller–Duval
bodies, glomerular-like.
02:54
Here, a yolk sac,the type of tumor marker you
would expect to find would bealpha fetoprotein
to be elevated.
03:01
Once you start getting
away from seminomatous,this obviously will be a
non-seminomatous testicular tumor,extremely aggressive,and here, the most
common testicular tumorin a boy less than
5 years of agewould be yolk sac tumor.
03:19
Something else that I wish
to bring to your attention.
03:23
When we get into ovarian tumor,remember that a seminoma is
then referred to as being --or it’s equivalent in a female
ovarian tumor is calleda dysgerminoma.
03:33
And these are thing that we’ll
discuss in ovarian tumor.
03:36
But you know me, I like to reinforce
information over and over again.
03:41
I want you to think.
03:43
This is choriocarcinoma.
03:45
Choriocarcinoma would be found
in two different locationsand that’s how you need to
approach the choriocarcinoma.
03:50
Pay attention.
03:51
Choriocarcinoma could
be either gestationalor could be non-gestational.
03:56
Either case, what do
we mean gestational?Well, you might have heard
of choriocarcinoma beingan issue with the
cancer of the placenta.
04:04
True.
04:05
For example, hydatidiform
mole, complete mole,may then give
rise to choriocarcinoma.
04:11
But that’s gestational cancer.
04:13
Where are you now?A gonad.
04:16
Which gender?The male, so testicles.
04:19
So this is testicular,
non-gestational choriocarcinoma.
04:23
Therefore, morphology, you would
expect to find placental tissue.
04:27
Trophoblastic.
04:28
"But Dr. Raj, we’re
in the testicle?"Yes, but this is cancer. It
can do whatever it wants.
04:33
Just like you would with any
type of placental disorderor in general
placentas involved,pregnancy, placenta involved.
04:42
And you’ve heard of the
pregnancy test, beta hCG.
04:45
Aggressive.
04:47
Here, once you start getting
away from your seminomatous,the non-seminomatous
will be hemorrhagic,hemorrhagic and spread also
would be hematogenous.
04:59
May result with hyperthyroidismand the reason for that is
because of increased hCG.
05:04
And if it’s a male, he may
present with gynecomastia.
05:08
Do no forget these features
of choriocarcinoma.
05:12
Teratoma.
05:14
Really, the only thing that I
wish to bring to your attentionbecause we’ll be dealing with
teratoma quite a bit in a female.
05:19
And a teratoma in female is
known as a cystic teratoma.
05:24
And with a female,we’ll be looking at the
mature teratoma more so,which is benign in a female.
05:30
In a male, quite different.
05:32
A teratoma is going to be
all three germ layers,so we have our endoderm,
ectoderm and our mesoderm.
05:39
And the immature form will be
extremely aggressive, malignant,and your next step of management
here will be to resect the tumor.
05:48
Benign in children,
tends to be a teratoma.
05:50
And in addition, keep
in mind that teratomacan be anywhere from head to toe
or head to basically the testicle.
05:58
So if it’s a child, you're most likely
thinking about the sacrococcygeal.
06:02
Can you picture that?Or it could be in the midline.
06:05
And we had this discussion
when we did our neoplasia.
06:08
By midline, I mean that it could
be part of your pineal glandor maybe perhaps in
your mediastinum.
06:13
Things that you want to pay
attention to teratoma.
06:16
At this point,we have finished our discussion
of germ cell tumors.
06:21
The most common family of
all testicular tumors,your focus definitely
should be on seminomaand some salient points about
each one these other types oftesticular germ cell tumors.

About the Lecture

The lecture Types of Germ Cell Tumors (GCT) by Carlo Raj, MD is from the course Male Reproductive System Diseases.

Included Quiz Questions

On physical exam you find a homogeneous and painless mass with the absence of hemorrhage. After surgery the pathologist reports "large cells in lobules with clear cytoplasm with a ‘fried egg appearance.'" Which of the following choices below matches this description?

Seminoma

Endodermal sinus tumor

Embryonal carcinoma

Yolk sac tumor

Choriocarcinoma

Which of the following statements is TRUE?

Seminoma is radiosensitive.

Seminoma is positive for alpha fetoprotein.

Seminoma usually is hemorrhagic in nature.

Seminoma is the least common GCT.

Seminoma carries a bad prognosis.

Which of the following combinations is INCORRECT?

Embryonal carcinoma
Tumor marker: lactate

Seminoma
Tumor marker: beta-HCG

Yolk sac tumor
Tumor marker: alpha-fetoprotein (AFP)

Choriocarcinoma
Tumor marker: beta-HCG

Seminoma
Tumor marker: placental alkaline phosphatase

Schiller-Duval body is seen in which of the following?

Yolk sac tumor

Teratoma

Seminoma

Choriocarcinoma

Leydig cell tumor

Author of lecture Types of Germ Cell Tumors (GCT)

Carlo Raj, MD

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